A 54-year-old man with type 2 diabetes has recently had an HbA1c reading of 60 mmol/mol. He is currently taking the maximum dose of gliclazide as he experiences frequent loose stools with any form of metformin. What additional treatment options would you suggest?
A 47-year-old woman with type 2 diabetes mellitus is being evaluated for exenatide treatment. What is not included in the NICE guidelines for initiating or maintaining this medication?
A 70-year-old retired carpenter visits his GP seeking strong pain relief for his lower back pain. He has been experiencing the pain for six weeks and saw another GP two weeks ago who advised him to take regular Paracetamol and Ibuprofen with PPI cover. During his previous visit, a PR exam was conducted, which was normal, and a PSA blood test was within the normal range. He reports feeling more tired than usual and complains of persistent nausea, but otherwise feels well. On examination, his observations are within the normal range, and there is no specific bony tenderness. His spine has a normal range of movement, and no focal neurology is detected. Based on NICE guidelines for suspected cancer, what is the most appropriate course of action?
A 72-year-old male presents with weight loss and heat intolerance. He is taking multiple medications for atrial fibrillation, ischaemic heart disease and rheumatoid arthritis. Thyroid function tests are requested and the results are shown in the table below:
Thyroid stimulating hormone (TSH) 0.2 mU/L
Free T4 35 pmol/L
What is the most likely cause of these findings?
A 30-year-old man is being treated for an exacerbation of his asthma. His doctor prescribes him prednisolone 40 mg once daily for 5 days. What is the recommended course of action after the 5 day treatment?
A 40-year-old wrestler presents with complaints of increased thirst and frequent urination. A urine dip reveals low specific gravity and no other abnormalities, and cultures come back negative. The recent venous blood gas results are as follows:
– Na+ 138 mmol/L (135 – 145)
– K+ 3.0 mmol/L (3.5 – 5.0)
– Glucose 3.9 mmol/L (3.6 – 5.3)
– Creatinine 60 µmol/L (55 – 120)
– Bicarbonate 27 mmol/L (22 – 29)
What is the most likely diagnosis?
A 56-year-old man presents with general malaise. He has recently been prescribed carbimazole for hyperthyroidism. What is the most crucial blood test to conduct?
You are assessing a 54-year-old man who has recently been diagnosed with type 2 diabetes. As part of his diabetic evaluation, he was instructed to perform home blood pressure monitoring. The average daytime reading has returned as 152/84 mmHg.
The patient migrated to the UK from Sudan approximately two years ago and has no significant medical history other than a vitamin D deficiency, which is believed to be due to his dark skin.
Based on the current NICE guidelines, what would be the most appropriate course of action in managing this patient?
A 54-year-old woman with established type 2 diabetes presents for her annual review. Her HbA1c has been stable on the maximal dose of metformin for the past few years and her BP has always been well controlled. She doesn’t take any other regular medications. Her HbA1c result 1 year ago was 52 mmol/mol.
The results of her most recent review are as follows:
HbA1c 59 mmol/mol
eGFR 91 ml/min/1.73m² (>90 ml/min/1.73m²)
Urine albumin:creatinine ratio (ACR) 2 mg/mmol (<3 mg/mmol)
BMI 25 kg/m²
QRISK score 6.8%
According to NICE guidelines, what is the most appropriate next step in managing her diabetes?
You are evaluating a 32-year-old woman with type 1 diabetes mellitus. She is currently in good control and has no concurrent illnesses. What is the recommended frequency for monitoring her blood glucose levels?